Abstract
BackgroundAlcohol consumption is an important risk factor for hepatic neoplastic and non-neoplastic diseases. Questions remain, however, about the relevance to disease risk of drinking patterns and alcohol tolerability, which differ appreciably between Chinese and Western populations.MethodsThe prospective China Kadoorie Biobank included 512,715 adults (41% men) aged 30–79 years recruited from ten areas during 2004–2008, recording alcohol intake, drinking patterns, and other characteristics. After median 10 years’ follow-up, 2531 incident liver cancer, 2040 liver cirrhosis, 260 alcoholic liver disease (ALD), and 1262 non-alcoholic fatty liver disease (NAFLD) cases were recorded among 492,643 participants without prior cancer or chronic liver disease at baseline. Cox regression was used to estimate adjusted hazard ratios (HR) relating alcohol intake and drinking patterns to each disease.ResultsOverall, 33% of men and 2% of women drank alcohol regularly (i.e. at least weekly) at baseline. Among male current regular drinkers, alcohol consumption showed positive dose-response associations with risks of several major chronic liver diseases, with HRs per 280 g/week (i.e. around four drinks/day) higher usual alcohol intake of 1.44 (95% CI 1.23–1.69) for liver cancer (n = 547), 1.83 (1.60–2.09) for liver cirrhosis (n = 388), 2.01 (1.77–2.28) for ALD (n = 200), 1.71 (1.35–2.16) for NAFLD (n = 198), and 1.52 (1.40–1.64) for total liver disease (n = 1775). The association with ALD appeared stronger among men reporting flushing (i.e., with low alcohol tolerance). After adjustment for the total amount of weekly alcohol consumption, daily drinkers had significantly increased risk of ALD (2.15, 1.40–3.31) compared with non-daily drinkers, and drinking without meals was associated with significantly greater risks of liver cancer (1.32, 1.01–1.72), liver cirrhosis (1.37, 1.02–1.85), and ALD (1.60, 1.09–2.33) compared with drinking with meals. Female current regular drinkers had significantly higher risk of ALD, but not other liver diseases, than female abstainers.ConclusionsIn Chinese men, alcohol intake was associated with significantly increased risks of several major chronic liver diseases, and certain drinking patterns (e.g. drinking daily, drinking without meals) may further exacerbate the disease risks.
Highlights
Alcohol consumption is an important risk factor for hepatic neoplastic and non-neoplastic diseases
In Chinese men, alcohol intake was associated with significantly increased risks of several major chronic liver diseases, and certain drinking patterns may further exacerbate the disease risks
China is a major contributor to the global burden of liver disease, accounting for over half of worldwide liver cancer cases and deaths, with approximately 300 million people being affected by chronic hepatitis B virus (HBV) infection and other chronic liver diseases [3]
Summary
Alcohol consumption is an important risk factor for hepatic neoplastic and non-neoplastic diseases. The associations have not yet been extensively investigated in low- and middle-income populations, including China where the main drinking patterns (predominantly drinking spirits, drinking with meals) and genetic tolerability of alcohol (due to a common loss-of-function variant of the ALDH2 gene, which causes an accumulation of toxic acetaldehyde that leads to the alcohol flushing response after drinking) differ importantly from the West [3, 8, 9]. Mainly involving Western populations, suggested that heavy alcohol use may interact with hepatitis C virus (HCV) infection [10, 11] and with certain metabolic risk factors (e.g. obesity, diabetes) [12] to affect the development and progression of chronic liver diseases, but how the associations of alcohol intake with liver diseases might be affected by other factors such as HBV, alcohol tolerability, and adiposity in relatively lean Asian populations remains unclear. Several previous studies in China have reported on the associations of alcohol consumption with risks of liver diseases, but most were conducted decades ago and are further constrained by small numbers of events, limited information on drinking patterns, and single baseline measurement of alcohol consumption [13,14,15,16]
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